Doctor: 'Gorgeous Gabby' recovering well after skull surgery

A day after she underwent skull surgery, Arizona congresswoman Gabrielle Giffords is looking and faring well, to the point that her doctor has taken to calling her "gorgeous Gabby."

The surgeries on Wednesday - a cranioplasty to replace her missing skull fragment and a shunt to drain excess fluid from her brain into her abdomen - represent "an important step in Gabby's recovery," said Dr. Dong Kim, director of Memorial Hermann's neuroscience institute.

Giffords experienced some pain and nausea following the 3½-hour surgery, doctors said, but was awake and eager to see what things looked like under her bandages.

"I started calling her 'gorgeous Gabby' today," Kim said. "She hasn't looked in the mirror yet, but as soon as she does, she'll be very pleased."

The cranioplasty had long been planned for some time in May, what doctors said was a typical time frame for patients who suffer similar trauma.

Doctors replaced Giffords' missing skull fragment with a computer-generated implant made of hydroxylapatite ceramic, a porous material in which her own bone cells can migrate into over the next several months.

Giffords had also developed mild hydrocephalus, or buildup of fluid in the brain -- "just like having a partially clogged drain," Kim said.

Prior to the procedures, the fluid did not cause any problems because it was coming out from under Giffords' scalp.

The shunt is a permanent and completely internalized system that will drain the excess fluid, Kim said.

The surgeries came two days after Giffords traveled to Florida to watch her husband, NASA astronaut Mark Kelly, launch into space on the shuttle Endeavour.

"Obviously it's a big week for us," said Pia Carusone, Giffords' chief of staff. "She was excited. It marks a major milestone for her."

Since the injury, Giffords has worn a specially fitted helmet, adorned with the Arizona flag, to protect her brain. Carusone said Giffords made no secret of her dislike of the helmet -- and that someone had written '5/17/11' on the headpiece to signify the last day she would have to wear it.

"She's been looking forward to this for a while," Carusone said.

Even though Kelly was away in space, Kim said it was the optimal time for surgeries.

"Mark and I had talked about this, and he had always said that he had wanted her care to be at the optimal time and not to be around his shuttle schedule or any of his work issues," Kim said.

Doctors did have to go against one of Kelly's wishes -- shaving off all of Giffords' hair once again for the surgeries.

"I said, 'Mark, it's hair. It will grow back.' And I want as little chance of infection as possible," Kim said. "I think it looks quite cute if you ask me, and her hair will grow back very evenly and soon."

Giffords will start bedside rehabilitation at Memorial Hermann while she fully recovers from the surgeries. Her doctors expect her to return to the inpatient facility at TIRR Memorial Hermann next week to resume full rehabilitation from the gunshot wound to the head she suffered in the Jan. 8 attack outside Tucson.

At that point, her doctors will reassess her to determine the next steps of her program, said Dr. Gerard Francisco, head of Giffords' rehabilitation team.

"It is not rare that after these procedures... that the patients who receive the shunt do even better, so I am so looking forward to that and hopefully we can upgrade her rehabilitation program," Francisco said. That could include increasing the level of difficulty on her current rehab activities, or coming up with new activities, he said.

He said Giffords has made even more progress since a brief, fuzzy video showed her climbing the stairs to a plane to attend Endeavour's first launch attempt three weeks ago.

"We're having more meaningful and fun conversations," Francisco said. "She's cracked me up several times."Her doctors would not reveal Giffords' tentative discharge date, and hedged on questions about whether she would be able to return to the political world.

"The rate of recovery is variable over time, and we can't predict how much more progress she's going to make going forward," Kim said. "So it's very hard to say if and when she would return back to work."